Umuziga Providence M, Gishoma Darius, Hynie Michaela, Nyirazinyoye Laetitia, Nsereko Etienne
Department of Mental Health Nursing, College of Medicine and Health Sciences, School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda.
Department of Psychology, York University, Toronto, ON, Canada.
Front Glob Womens Health. 2023 Jul 21;4:1113483. doi: 10.3389/fgwh.2023.1113483. eCollection 2023.
Postnatal depression is a significant public health issue that demands attention, and recent evidence indicates that rates are relatively high in low-income countries such as Rwanda. However, lack of social support is recognized as a potential risk factor for postnatal depressive symptoms. This study sought to explore the influence of poor maternal social support on postnatal depressive symptoms in a sample of women in Rwanda.
A prospective cohort research design was conducted with women recruited from four different health centers in Rwanda's Southern Province. A sample of 396 pregnant women accessing antenatal care services was recruited at the baseline from their late second term or later, then followed up after giving birth. The dropout rate was 21.46%; thus, the data of 311 women were analyzed. The outcome variable was the presence of depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS) (≥12 cut-off score), while predictor variables included maternal social support measured using a modified Maternal Social Support Scale (MSSS), perceived health status, socio-demographic information (marital status, wealth class, age, education, occupation), negative life events, gestational and obstetric information (parity, pregnancy intention, age at birth, children given birth, and mode of delivery). Univariate and multivariate analyses were performed.
From a sample of 311 participants, over a quarter (20.9%) had elevated postnatal depressive symptoms (EPDS ≥ 12 scores). Elevated scores were predicted by poor perceived health status; respondents reporting neither poor nor good (AOR=0.28, CI = 0.11; 0.72, = 0.007) or good health (AOR=0.14, CI = 0.05; 0.37, = 0.001) were less likely to be affected. Poor maternal social support was also linked with postnatal depressive symptoms; poor partner support (AOR=4.22; CI = 1.44; 12.34; = 0.009) was associated with high risk, while good friend support (AOR = 0.47, CI = 0.23; 0.98, = 0.04) was a significant protector. Additionally, violence or negative life events were also independent predictors of postnatal depressive symptoms (AOR: 2.94, CI: 1.37-6.29, = 0.005).
Postnatal depressive symptoms were found to affect one in five Rwandan women. However, good maternal social support can be a strong protector. Early interventions targeting mothers in the postnatal period and strengthened social support networks for women at risk should be developed.
产后抑郁症是一个需要关注的重大公共卫生问题，最近的证据表明，在卢旺达等低收入国家，产后抑郁症的发病率相对较高。然而，缺乏社会支持被认为是产后抑郁症状的一个潜在风险因素。本研究旨在探讨卢旺达妇女样本中不良的孕产妇社会支持对产后抑郁症状的影响。
采用前瞻性队列研究设计，从卢旺达南部省的四个不同卫生中心招募妇女。在基线时，从妊娠晚期（即孕28周及以后）接受产前护理服务的396名孕妇中抽取样本，产后进行随访。失访率为21.46%；因此，对311名妇女的数据进行了分析。结果变量是抑郁症状的存在情况（爱丁堡产后抑郁量表（EPDS）（临界值≥12分），而预测变量包括使用改良的孕产妇社会支持量表（MSSS）测量的孕产妇社会支持、感知健康状况、社会人口学信息（婚姻状况、财富等级、年龄、教育程度、职业）、负面生活事件、妊娠和产科信息（产次、妊娠意愿、生育年龄、生育子女数和分娩方式）。进行了单因素和多因素分析。
在311名参与者的样本中，超过四分之一（20.9%）的妇女有产后抑郁症状加重（EPDS≥12分）。感知健康状况不佳可预测得分升高；报告健康状况既不差也不好（比值比=0.28，可信区间=0.11；0.72，P=0.007）或健康状况良好（比值比=0.14，可信区间=0.05；0.37，P=0.001）的受访者受影响的可能性较小。不良的孕产妇社会支持也与产后抑郁症状有关；伴侣支持不足（比值比=4.22；可信区间=1.44；12.34；P=0.009）与高风险相关，而好友支持良好（比值比=0.47，可信区间=0.23；0.98，P=0.04）是一个重要的保护因素。此外，暴力或负面生活事件也是产后抑郁症状的独立预测因素（比值比：2.94，可信区间：1.37 - 6.29，P=0.005）。
发现五分之一的卢旺达妇女受到产后抑郁症状的影响。然而，良好的孕产妇社会支持可以成为一个强大的保护因素。应制定针对产后母亲的早期干预措施，并加强对有风险妇女的社会支持网络。
